Subjective assessment

Question 1

Red flag: how much weight loss is concerning/ a red flag indicator?

Answer 1

A loss of 5% of total body weight over the past month - if unexplained

Question 2

What are the special questions for the C spine/ shoulder?

Answer 2

5Ds + 3Ns:
- Dizziness
- Diplopia = double vision or seeing double
- Dysphagia = swallowing difficulties
- Dysarthria = speaking difficulties
- Drop attacks = sudden falls with or without loss of consciousness

• Numbness = Bilateral pins and needles
• Nausea = feeling the need to vomit
• Nystagmus = a rhythmical, repetitive and involuntary movement of the eyes

Question 3

what are the specail questions for the Lx spine/ hip?

Answer 3

WUSS FG:
-Widespread weakness
- Urinary retention
- Saddle anaesthesia = reduction in sensation, pins and needles, numbness
- Sexual dysfunction

• Faecal incontinence
• Gait disturbances

Question 4

List all the areas with additional red flag questions

Answer 4

• C spine/ shoulder: 5Ds + 3Ns
• L spine/ hip: WUSS FG
• Hip and knees: CB GRLS
• general red flags: PUNTS FWC

Question 5

What are the special questions for the hip and knee?

Answer 5

CB GRLS:
- Clicking
- Brusing
- Giving way
- Redness
- Locking
- Swelling

Question 6

What are the special questions/ general red flags?

Answer 6

General health, THREADS, PUNTS FWC
- Personal family history of cancer
- Unexplained weight loss: Can this be explained (a loss of 5% of total body weight over the past month = red flag)
- Night sweats / fevers
- Thoracic pain
- Systemically unwell

• First onset of back pain between the age of 20yrs - 55yrs
• Widespread neurological symptoms
• Constant non-mechanical pain

Question 7

What are the most common severe/ progressive bilateral neurological deficits seen with pts suffering from cauda equina?

Answer 7

Knee extension
Ankle eversion
Foot dorsiflexion

Question 8

List the key things to look out for with cauda equina

Answer 8

WUSS FG =
- Widespread weakness
- Urinary retention/ increased difficulty to urinate - recent need to use pads or not knowing when bladder is full or empty.
- Saddle anaesthesia (between inner thighs or genitals) = reduction in sensation, pins and needles, numbness
- Sexual dysfunction (loss of sensation in genitals during sexual intercourse)

• Faecal incontinence
• Gait disturbances

Question 9

List the key symptoms to look out for with a spinal fracture

Answer 9

• Sudden onset of severe central spinal pain which is relieved by lying down
• History of major trauma (road traffic collision or fall from height)
• Minor trauma in pts with osteoporosis or that who use corticosteroids
• Structural deformity of the spine
• A point tenderness over a vertebral body

Question 10

list the symptoms to look out for in cancer

Answer 10

Pt <50 yrs of age
Gradual onset of symptoms
Severe unremitting pain that remains when pt is supine
Aching night pain that prevents or disturbs sleep
Pain aggravated by straining
Thoracic pain
Localised spinal tenderness
No symptomatic improvement after four to six weeks of conservative low back pain therapy
Unexplained weight loss
PMH of cancer

Question 11

What symptoms to be aware of with MND?

Answer 11

Bulbar features (involving the medulla oblongata):
- Dysarthria (problems speaking)
- Dysphagia (Swallowing difficulties)
- Tongue fasciculations
Limb features
- Focal weakness
- Falls
- Loss of dexterity
- Muscle atrophy/ cramps
- No sensory features
Respiratory features
- SOB on exertion
- Excessive daytime sleepiness
- Orthopnoea (breathless in supine which is relieved when sitting or standing)
Cognitive features
- Behavioural change
- Fronto-temporal dementia

Question 12

Symptoms that rule out MND

Answer 12

• Bladder/ bowel involvement
• Double vision/ Ptosis
• Improving symptoms

Question 13

Name the 10 respiratory red flags

Answer 13

Chest pain
Haemoptysis
Night sweats
Drowsiness
Cyanosis
Clubbing
Peripheral / Pitting oedema
Raised temperature
Unexplained weight loss
Nocturnal cough/ wheeze

Question 14

What are the types of psychosocial flags (yellow flags)?

Answer 14

Psychiatric symptoms: clinical depression, personality disorder
Work-health relationships
System/ contextual obstacles: Legislation restricting options to return to work, Insurance claims
Pain behaviour & coping strategies: Avoidance of activities, relying on passive treatment
Emotional Responses
Beliefs & judgements: Unhelpful beliefs about pain/injury, expectations of poor treatment outcome

Question 15

What are the key questions to ask regarding yellow flags?

Answer 15

What do you think has caused the problem
What do you expect is going to happen
How are you coping with things
What can be done to help

Question 16

what are the key components to the bio-psychosocial model assessment?

Answer 16

Attitudes: How they feel regarding the current problem, positive or negative attitude regarding pain and treatment plan - do they think they can return to normal activities
Beliefs + Behaviours: belief that injury is something serious? Catastrophising, fear avoidance.
Compensation: awaiting a claim to be processed - work related or road traffic accident
Diagnosis: previous treatment - conflicting diagnosis from prior therapist
Emotions: underlying emotional/psychological issues? Eg: anxiety / depression. High risk of developing chronic pain?
Family: Supportive or overbearing?
Work: Currently working or not? Financial implications?